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Government Insurance and Higher Area Deprivation Index Associated With Increased Time to Care in Patients With
Vibav H Mouli1, Allan K Metz, Eileen A Crawford
1From the Department of Orthopaedic Surgery (Dr. Mouli), Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; the Department of Orthopaedic Surgery (Dr. Metz), University of Utah, Salt Lake City, UT; and the Department of Orthopaedic Surgery (Dr. Crawford), University of Michigan, Ann Arbor, MI.
Introduction:
Patellar instability is an increasingly prevalent condition in the adolescent population, often requiring surgical intervention for traumatic or recurrent dislocations. Despite growing recognition of health disparities in orthopaedic surgery, little is known about sociodemographic factors associated with delays to care. We hypothesized that government insurance and higher Area Deprivation Index (ADI) would be associated with increased time to care.
Methods:
A retrospective review was conducted of pediatric patients (ages 7 to 19 years) undergoing surgery for traumatic patellar instability at a single institution from September 2015 to September 2022. Demographic characteristics, ADI scores, and time-to-care variables were collected including time to first visit, magnetic resonance imaging (MRI), and day of surgery. Multivariable linear regression analyses were conducted with sex, race, insurance status, and ADI as independent variables.
Results:
A total of 118 patients were included (mean age 15.0 ± 2.0 years; 54.2% female). Higher ADI was significantly associated with longer time from injury to the first visit (β = 0.1, P = 0.042) and from the first visit to MRI (β = 1.9, P = 0.041). Government insurance was significantly associated with longer time from surgical decision to surgery (β = 24.6, P = 0.019). No notable associations were found for sex or race.
Conclusion:
ADI and public insurance are two sociodemographic factors associated with delays to care for pediatric patients treated with surgery after traumatic patellar instability. Longer care journeys in this population may affect patients' quality of life. Additional efforts are warranted to mitigate these potential health disparities and ensure more equitable care delivery.